Klin Onkol 2018; 31(3): 207-2012. DOI: 10.14735/amko2018207.
Background: Patients with advanced anaplastic lymphoma kinase (ALK) -positive non-small cell lung cancer (NSCLC) may gain significant benefit from treatment with the first-generation ALK inhibitor crizotinib. This study investigated the effects of crizotinib in advanced ALK-positive NSCLC patients via analyzing data submitted to the TULUNG registry by pneumo-oncology centers in the Czech Republic. Patients and methods: We analyzed the data of 60 NSCLC patients submitted to the TULUNG registry by pneumo-oncology centers who had ALK translocation confirmed by fluorescence in situ hybridization and complete data records from 2011 to 2017. Results: The median age of patients was 58 years. A total of 53% of patients were men, 90% had adenocarcinomas, 61.7% were smokers or ex-smokers, and 65% had a performance status of 0. Upon initiation of crizotinib therapy, most patients were at stage IV (88.3%) and the remainder were at stage IIIA or IIIB. Crizotinib was the second-line therapy in 71.7% of patients. A total of 20% of patients suffered side effects, while 11.7% suffered grade 3 and 4 adverse effects. A total of, 6.7, 25, 21.7, and 25% of patients displayed a complete response, a partial response, stable disease, and progressive disease, resp. Progression-free survival (PFS) was 5.8 months. Overall survival (OS) was 27.9 months from the initiation of the first-line therapy and 12.6 from the initiation of crizotinib therapy. PFS and OS were longer among nonsmokers and ex-smokers than among smokers (PFS, 9.7 vs. 5.8 vs. 3.8 months, p = 0.029; OS, 26.8 vs. 15.3 vs. 7.0 months, p = 0.015). Conclusion: Targeted crizotinib therapy is well tolerated and has significant benefit in patients with advanced ALK-positive NSCLC. Although international guidelines recommend that crizotinib is only used as a first-line therapy, it is used as a second-line and higher-line therapy in the Czech Republic. Clinical studies provide evidence that targeted therapy elicits better effects and less toxicity than routine chemotherapy.
